Uncovering our medical instruments – British Science Week 2017

In June 2016 we started an exciting project to digitise items from our museum collection. The project, which has been kindly funded by Museums Galleries Scotland, is sadly nearly at an end, so to celebrate all the amazing work that has been done we’re hosting a special drop-in session as part of British Science Week.

The drop-in session will give visitors the opportunity to view some items from our collection, learn about how they were used, take a look at the processes involved in their digitisation, and maybe take a few photos too!

The drop-in session takes place on Wednesday, 15th March 2017 from 1pm – 3pm. No need to book – just pop in to the College!

Horsley's Skull Trephine

Horsley’s Skull Trephine

So far, our digitisation intern has photograph over 300 items including our collection of 18th/19th century stethoscopes, apothecary cabinets, the surgical instruments of William Beatty (surgeon on board HMS Victory at the battle of Trafalgar), early 19th century x-ray tubes, Victorian quackery gadgets, and many other fascinating surgical instruments.

Surgical Instruments of William Beatty

Surgical Instruments of William Beatty

The collection dates back to the mid 1700s – the earliest item we have is a trephine set – and covers all areas of medicine, surgery and dentistry. You can read a little bit more about some of the items we’ve digitised and get updates on the project on our blog.

For more information on British Science Week 2017 please visit: https://www.britishscienceweek.org/

Flyer for our British Science Week event

Flyer for our British Science Week event

Amputation

In this post by our Digitisation Project Intern, we look at our amputation instruments, while referring to the work of Maister Peter Lowe, College founder and 16th century surgeon.

The surgical procedure of an amputation involves the removal of a section of a limb of the body. The volume of tissue removed from the body depends on a variety of factors, including the severity of the patient’s condition.

instruments-and-cauters-actuals-for-extirpation-copy

Woodcut illustration, 2nd ed. of Lowe’s Chirurgerie (1612)

 

It is uncertain as to how long amputations have been a regular form of surgical treatment, however the term can be traced back to the 16th century. For example, Peter Lowe uses the term “amputation” when describing how to treat a gangrenous limb in his 1597 work The Whole Course of Chirurgerie [1].  Here he explains how the operation should be carried out, referencing the works of previous scholars:

The judgements are, that it is for the most part incurable, and the patient will die in a cold sweat. The cure, in so much as may be, consists only in amputation of the member, which shall be done in this manner, for the patient must first be told of the danger, because often death ensues, as you have heard, either from apprehension, weakness, or loss of blood.”

It has only been within the last 170 years that amputations, and surgical procedures in general, have been performed in a safe manner, e.g. with the patient under anaesthesia. Prior to this, the limb was removed as quickly as possible. A successful and speedy amputation required precision, strength, skill, and a steady hand, as well as a set of sharp amputation instruments!

amputation-set

Mid 19th century amputation set

 

Within the museum collection are examples of amputation sets from the 1800-1900s.

Several components make up a set, from trephine heads to amputation saws to tourniquets. Each instrument would be used at a different stage of the surgical procedure. Let’s take a look at how a lower limb amputation would be performed.

First of all, the patient would be prepped for the surgery. In the days before pain relief, alcohol was the method used to calm the nerves. The patient would be given some rum or whisky, and then wheeled into the surgical theatre. Most likely the theatre would be structured with the operating table in the centre of the room surrounded by rows and rows of stands for spectators. Spectators would include the students of the chief surgeon involved in the procedure- not only was this a surgical operation, it was also a lesson. Once the patient was placed on the operating table, the chief surgeon would enter the theatre and the operation would commence.

One of the major dangers of amputating a limb is blood loss. Several blood vessels must be carefully salvaged during the procedure in order to limit haemorrhaging [1]. To enable the surgeon to operate on a bloodless area of the body, a Tourniquet was applied proximal to the site of amputation (a couple of inches above the site of incision).

“The use of the ribband is diverse. First it holds the member hard, that the instrument may curve more surely. Secondly, that the feeling of the whole part is stupefied and rendered insensible. Thirdly, the flow of blood is stopped by it. Fourthly, it holds up the skin and muscles, which cover the bone after it is loosed, and so makes it easier to heal.”[1]

tourniquet

Example of a tourniquet from an amputation set

 

The tourniquet would have been tightened in order to restrict blood flow and reduce haemorrhaging. It would also have reduced sensation to the limb, providing slight pain relief. However, this would also mean that oxygen was restricted. Hence another reason as to why amputations were performed as quickly as possible.

tourniquet-illustration

The initial incision would have been made with a sharp amputation knife. Amputation knives evolved in shape over the years, from a curved blade to a straight blade. Peter Lowe comments on the use of a curved blade for the procedure:

“…we cut the flesh with a razor or knife, that is somewhat crooked like a hook…”[1]

The blade was curved in order to easily cut in a circular manner around the bone (see image from Lowe’s book above) [2]. Amputation blades became straighter as the incision technique evolved. An example of a straight amputation knife is that of the Liston Knife. With a straight and sharp blade, this knife was named after the Scottish surgeon Robert Liston. Liston is best known for being the first surgeon in Europe to perform an amputation procedure with the patient under anaesthesia [3].

liston-knife

Liston knife, mid 19th century

 

The straight blades enabled the surgeon to dissect more precisely in order to form the flap of skin and muscle that would become the new limb stump.

As one can imagine, bone tissue would not be easily removed by an amputation knife. Instead, an amputation saw was required to separate bone. Amputation saws were similar to those found in carpentry, with sharp teeth to dig into and tear bone tissue for a quick procedure.

amputation-saw

Amputation saw, mid 19th century

 

Aside from the major dissecting tools, there are more specialised instruments within an amputation set that we must consider. One of the main risks of an amputation operation was death by haemorrhaging. For years, the letting of blood was used to treat certain ailments according to the ancient teaching of the “Four Humors”. However, in a surgical procedure the major loss of blood was something to be avoided. In order to prevent the haemorrhaging of dissected vessels, the surgeon would have used a Ligature to tie off the vessel and disrupt blood flow. This technique was pioneered by French surgeon Ambroise Paré during the 1500s [4].

Found within our amputation sets are trephine heads with accompanying handles. Rather than being used during an amputation procedure, trephine heads were used to drill into the skull to treat conditions by relieving intracranial pressure. Nowadays, access to the brain via the skull is achieved with the use of electric drills.

trephine1

Trephine, mid 19th century

 

Amputation procedures have changed dramatically since the days before anaesthesia and antiseptics, but the risks have remained. Blood loss, sepsis, and infection are factors that can still occur today. Thankfully, their likelihood is much lower than they were 170 years ago.

References

  1. Lowe, P., 1597. The Whole Course of Chirurgerie.
  2. Science Museum, 2016. Amputation Knife, Germany, 1701-1800. Brought to Life: Exploring the History of Medicine. [online] Available at: http://www.sciencemuseum.org.uk/broughttolife/objects/display?id=5510
  3. Liston, R., 1847. To the Editor. The Lancet, 1, p. 8.
  4. Hernigou, P., 2013. Ambroise Paré II: Paré’s contribution to amputation and ligature. International Orthopaedics, 37(4), pp. 769-772.

The semi-flexible gastroscope

In her latest blog post, Digitisation Project Intern Kirsty Earley looks at the technology behind a mid 20th century gastroscope.

The development of gastroscopy and endoscopy evolved during the 19th century. Philipp Bozzini in the early 1800s is regarded as the first to attempt to see inside the body using a light source – at this stage candlelight and mirrors. The use of electric light in the later 19th century advanced the procedure. In 1868 Adolph Kussmaul tested a rigid gastroscope on a sword-swallower to establish the line from mouth to stomach.

mayer-and-meltzer-gastroscope-c-1914a

Rigid gastroscope in Mayer & Meltzer catalogue, c1914

Prior to any form of recording technology, visualization of the gastrointestinal tract could only be achieved via rigid gastroscopes. These were essentially long telescopes through which the physician could view inside of the patient’s stomach (see illustration above and below).

gastroscope-illustration

Due to the limitations on flexibility, the patient had to be positioned in order that the gastroscope could simply slide down the oesophagus towards the stomach. It would then be rotated to visualize all areas of the stomach. Not the easiest of procedures. For gastroscopy to advance, something had to be done to the gastroscope itself.

Rudolf Schindler (1888-1968) was a German doctor who specialised in gastroenterology. Considered the “father of gastroscopy”, Schindler made incredible efforts to promote the use of gastroscopy as a diagnostic technique for gastrointestinal conditions [1].

Schindler was the brains behind the first ever semi-flexible gastroscope, created in 1931 [2]. He constructed the gastroscope in such a manner that the distal end could be rotated, while the proximal end remained stationary (see image below). This allowed easier access to all areas of the stomach. But how did he test his design? Often, his instruments were tested on his own children, especially his daughter Ursula as she had a strong gag reflex [3].

2000-10-2_gastroscope-2

One of our mid 20th century gastroscopes

To ensure that procedures were being carried out safely, Schindler trained practitioners in how to use his gastroscope as a diagnostic tool. He argued for many years that gastroscopy should not become a specialised field of medicine, but an examination technique performed by any level of practitioner.

2000-10-2_gastroscope-7

Detail of mid 20th century gastroscope

Ultimately, the gastroscope was replaced by fiberoptic endoscopes [4]. Instead of a flexible distal end, the entire length of the fibreoptic endoscope was flexible. This allowed the patient to be in a more natural position, e.g. sitting up, during the examination, [5].

Gastroscopy today involves examining components of the gastrointestinal system by inserting a wire-like endoscope down the patient’s throat. The endoscope contains a camera and light, and is controlled by the physician performing the examination. The images from the camera are then fed to a monitor screen for visualization.

References

  1. Gerstner, P., 1991. The American Society for Gastrointestinal Endoscopy: a history. Gastrointestinal Endoscopy, 37(2).
  2. Olympus, date unknown. Olympus History: VOL 1 The Origin of Endoscopes. [online] Available at: http://www.olympus-global.com/en/corc/history/story/endo/origin/.
  3. Schindler Gibson, U., 1988. Rudolf Schindler, MD: living with a Renaissance man. Gastrointestinal Endoscopy, 34(5).
  4. DiMarino, A.J., and Benjamin, S.B., 2002. Gastrointestinal Disease: An Endoscopic Approach. Slack Incorporated: New Jersey.
  5. Hirschowitz, B., 1961. Endoscopic Examination of the Stomach and Duodenal Cap with the Fiberscope. The Lancet, 277(7186).

Old and new surgical tools

Our Digitisation Project Intern expands on the previous post about Dr Harry Lillie’s medical bag.

The recent donation of a medical bag belonging to Dr Harry R.Lillie, a medical officer aboard whaling ships during World War Two, revealed some interesting stories. It also highlighted fascinating insights in the development of basic surgical instruments.

hr-kit-3

Dr Lillie’s surgical kit

Within the bag, one item drew much attention- a set of surgical tools (above). These tools drew attention not because of their scarcity, or obscurity, but because of their profound similarities to modern tools used today.

hr-kit-7

1939 or 2016?

A set of modern dissection tools was located and compared with the surgical tools found in Lillie’s surgical case. The designs of the tools are very similar, as are their materials. Modern dissection tools are made of stainless steel, as are Lillie’s. Most surgical instrument makers adopted stainless steel since its popularity grew in the 1930s. Even the canvas bags are remarkably similar.

kirstys-tools

2016 or 1939?

Apart from some signs of wear and tear, it is hard to believe these two surgical kits have over 75 years between them.

 

Dr Harry R. Lillie

We recently received an unusual donation, and one that holds an incredible story. A medical bag belonging to Dr Harry R. Lillie was generously given to the College, along with a copy of his book The Path through Penguin City (1955). In this blog post our Digitisation Project Intern Kirsty Earley explains its significance.

dr-hr-lillie

Dr Lillie’s medical bag

 

Dr Harry Russell Lillie was a surgeon and medical officer aboard British whaling ships in the Antarctic during the 1940s. Originally from Dundee, Lillie received his MB ChB from the University of St Andrews in 1939, previously graduating with a BSc Engineering in 1926.

hr-blood-pressure

Dr Lillie’s Baumanometer

He began his career at sea during the whaling season of 1946-1947. Serving up to 600 sailors at a time, Lillie was putting his surgical skills to good use at sea [1]. Life at sea was always busy, and certainly not a 9-5 job. Surgeons and medical officers had to be ready to deal not only with common illnesses contracted at sea, but also severe injuries of the whaling profession. It wasn’t unheard of for sailors to find themselves inside the mouth of the whale they were trying to hunt:

“Trapped with only his boots sticking out as the jaws came together, he got off with a moderately crushed chest and emphysema from the neck to the waist, but was back on his job in six weeks.” [1]

hr-kit-3

Dr Lillie’s surgical kit

As well as exercising his medical skills, Lillie was able to observe the conditions and methods of whaling in the Antarctic. The hunting of whales has been performed since prehistoric times, however the reasons for hunting whales has changed over time. Whales have been targeted as a food source for some communities, as well as being killed for oil and blubber.

The tools used to kill whales have evolved over the years. Lillie describes in detail the specific methods sailors used to take down their prey, and, as the true scientist he was, didn’t leave out any details. “Explosive Harpoons” were used to take down the whale instead of standard iron harpoons used previously. These harpoons had a delayed mechanism, where the spear would pierce the whale’s tissue, and then explode via implanted grenades after a few seconds. As would be expected with such a large mammal, death wasn’t immediate; often it required several hours for the whale to die after more than one harpoon fired.

Such scenes were the cause of Lillie’s campaigning for new whaling laws. He reported the horrific methods used to kill whales to make a clear point- things had to change. And things did change. His book The Path through Penguin City was published in 1955 and remains to be one of the most influential books in whaling conservation. Here he uses helpful imagery to explain the how horrible whaling was:

“If we can imagine a horse having two or three explosive spears stuck in its stomach and being made to pull a butcher’s truck through the streets of London while it pours blood into the gutter, we shall have an idea of the method of killing. The gunners themselves admit that if whales could scream the industry would stop, for nobody would be able to stand it.” [2]

It was this work that led to the formation of several conservation groups, including the International Whaling Commission, [3]. In fact, Sir David Attenborough has quoted Lillie’s work when discussing the still present inhumane methods of whaling [4].

With such an interesting background, it is safe to say that there is still much to discover about H.R.Lillie, his workings as a surgeon and as a conservationist.

References

  1. Lillie, H.R., 1949. With whales and seals. The British Medical Journal, 2(4642), p.1467-1468.
  2. Lillie, H.R., 1955. The Path through Penguin City. Benn Publishers.
  3. Society for the Advancement of Animal Wellbeing. Whaling. Available at: http://www.saawinternational.org/whaling.htm.
  4. Kirby, A., 2004. Whaling too cruel to continue. BBC News. [online] Available at: http://news.bbc.co.uk/1/hi/sci/tech/3542987.stm.

Uncovering our Medical Instruments

We recently appointed a Digitisation Project Intern for Uncovering our Medical Instruments, a project which aims to make our collections much more accessible and visible. Kirsty will be photographing and researching our instrument collection, and sharing them as much as possible, via this blog, @RCPSGlibrary and the Museum Collection pages on our website.

Opthalmic Mask Higher Exposure

Ophthalmic Phantom, c1900 – 1920 (for teaching eye surgery)

The project will delve into our Instrument Store to uncover medical and surgical instruments and equipment that is rarely seen. These collections date from the 18th – 20th century, many with a link to Glasgow. As well as making these collections more visible online, the project will also contribute to our exhibition programme and pop-up displays.

Photography set up 3

Pop-up studio

So far Kirsty has been trying out some new kit and testing backgrounds. Many of the instruments are metallic so achieving the right conditions for digitisation can be challenging. The collections also vary in size, from tiny surgical needles to heavy respiratory equipment. Some items can’t be displayed traditionally, so we will develop digital displays to complement our exhibition space.

WT microscope side view high contrast

Wilson Type Microscope

Uncovering our Medical Instruments is a nine month project, kindly supported by Museums Galleries Scotland. During that time, we hope to provide access to hundreds more instruments from our collections.

Digitising our Historical Collections

If you’ve been following our blog you may have noticed a couple of posts referring to our collection of Digital Volumes. This collection includes some unique items from the College Archive that have been made available online as part of our ongoing digitisation project.

Like most libraries and archives, we are keen to improve access to our resources. By digitising some of these items and making them available online, we hope to make them accessible to a wider audience and help to ensure the long-term preservation of some of our fantastic historical resources.

The scanner we use for this was built by a member of the College who wanted to scan the minutes of the Glasgow Southern Medical Society. When this was complete, he very kindly donated the scanner to the library. The scanner includes a V-shaped book cradle, which is less likely than a flatbed scanner to cause damage to the book or its binding.

scanner

Our custom book scanner

As mentioned in a previous post, we get a lot of help from volunteers, and most of our scanning to date has been done by volunteers. Anna Käyhkö worked with us through Glasgow University’s Club 21 internship programme, and Jane Mycock helped us while studying for her PhD at Strathclyde University. Scanning and processing the images for digital volumes is a time consuming process, and we’re very grateful to Anna and Jane for their help.

DIY Digitisation: Some Technical Points

Our digitisation project is quite a DIY affair. We try to use free and open source software as much as possible when creating our digital volumes, and our scanner was hand-built by a member of the College using guidelines from the DIY Book Scanner online community.

We use two compact cameras to capture the images. These aren’t professional cameras, so we use the tools CHDK and CardTricks to let us capture images in a raw format, and to let us fire the shutters on both cameras simultaneously.

We prefer to work with and store the images in TIF format, so we use IrfanView to convert from CRW to TIF. We also use IrfanView for file renaming and any other batch processing.

We edit the images and prepare them for the web using ScanTailor. Once the images are ready, we combine them into a single PDF using Photoshop CS6, and upload to the Internet Archive. Finally, we embed the content from the Internet Archive in the Digital Volumes collection on our website.

Our digitisation project is ongoing, and we are adding new content on a regular basis. Keep an eye on the website, and don’t forget to follow us on twitter @rcpsglibrary for frequent updates.